Patient Preferences Regarding Shared Decision Making in the Emergency Department: Findings From a Multisite Survey

Abstract

We found that the majority of ED patients in our large, diverse sample wanted to be involved in medical decisions, especially in the case of a "serious" medical problem, and felt that they had the ability to do so. Nevertheless, many patients were unlikely to actively seek involvement and defaulted to allowing the physician to make decisions during the ED visit. After fully explaining the consequences of a decision, clinicians should make an effort to explicitly ascertain patients' desired level of involvement in decision making.

Does Shared Decision Making Actually Occur in the Emergency Department? Looking at It from the Patients’ Perspective

“…We administered an instrument that included three different SDM‐related scales (two validated and one newly developed) to a cross‐section of alert, stable adult patients at two academic EDs. The composite instrument described here was the 17‐item second section of a two‐part (total 36‐item) instrument regarding patient's preferences in decision making . The entire instrument is available in the Data Supplement S1 (Appendix S1, available as supporting information in the online version of this paper, which is available at http://onlinelibrary.wiley.com/doi/10.1111/acem.13850/full).…”

“…Verbal informed consent was used to maintain confidentiality, and trained research assistants (RAs) administered the survey either in verbal or in written form. Screening logs were maintained to record reasons for exclusions and refusals and to ensure that patients with multiple ED visits were only enrolled once; these data have been published previously . Overall sampling was based on RA availability (i.e., convenience sampling,) but RAs attempted to enroll a consecutive sample of patients available during their shifts across various days and time spans.…”

“…To assess choice awareness, we asked two additional questions. The first question was to categorize any decision‐making conversations participants had with their clinician (e.g., admission vs. discharge, one medication vs. another), including a response option for “We did not discuss any decisions.” Second, we asked whether respondents were “as involved in today's decisions as you would have liked to be” with three response options “Yes, I was as involved as I wanted to be,” “No, I would have liked to be more involved,” and “Not applicable, there were no decisions for me to be involved in today.” These questions were developed from the study team's qualitative work and were subject to multiple rounds of cognitive interviewing and piloting (Data Supplement S1, Box 3) …”

“…The final instrument contained 17 items, 15 of which were drawn from validated scales. It was administered as a section of a 36‐item instrument assessing preferences (Control Preferences Scale), experiences of care, and demographics (see Data Supplement S1, Appendix S1) . Some patients responded to both sections at the same time, if their ED care was complete, while others responded to the longer first section (that included 10 demographics items) while waiting for tests and then completed the instrument described here only when a disposition decision had been made and communicated.…”

“…Many emergency department (ED) patients want to be part of medical decision making when multiple, reasonable options are available . Shared decision making (SDM)—the conversation between patients and clinicians where clinicians describe options and share their expertise and patients contribute their values and preferences—has been gaining increased recognition in emergency medicine .…”